Patients' Expectations of Activity Following Knee Replacement Not Realized

Tuesday, April 17, 2012

Patients' Expectations of Activity Following Knee Replacement Not Realized

Following knee replacement surgery, patients' physical activity levels are significantly lower than what they expected they would be, says a Reuters Health article based on study in The Journal of Arthroplasty.

Researchers surveyed 83 patients with arthritis who were about to have a knee replaced, then questioned them again 1 year after the procedure. At the time of surgery, study participants reported that they were active about 2 hours a week, "mostly doing moderate-intensity activities such as yard work, strength training, and walking."

The patients expected to spend about 23 hours per week exercising 1 year after their surgery, the article says. According to the second survey, people were more active postsurgery but not to the degree that they had anticipated, averaging 11 hours a week of activity.

Lead author and APTA member Dina Jones, PT, PhD, said the reason people's expectations don't match reality is likely because those expectations are rarely brought up in presurgery conversations, which usually focus on the knee's function immediately after the operation.

Even if surgeons don't always discuss long-term exercise goals with patients, "from the data we've collected I don't see anything that says physicians are telling people they'll have more function than they used to," Jones told Reuters Health.

Jones and her colleagues are working on developing educational pamphlets and presentations that would help people manage their exercise-related expectations for after knee replacement.

Comments

Most Ironman age-group triathletes do not train 23 hours in a week. Where did this number come from in the study? 3.5 hours per day of exercise is a tremendous amount for anyone!

Posted by John Scandura
on 4/17/2012 4:17 PM

One of the other considerations is that oftentimes in the Orthopedic community, and certainly in at least some of that literature (though I've not read this particular article), is the concept shared by many Orthopedic Surgeons that the "Standard of Care" for arthroplasties frequently involves very little, if any, formal outpatient Physical Therapy afterwards.
A commonly thought "Standard of Care" is gradual return to prior activity following the initial bout of rehab or home therapy. For many and maybe more likely the great, great majority of the these patients would benefit from more formal attention to the details of technique and progression of their appropriate ROM work, strengthening, proprioceptive ex's. Post-op PT is not a cookbook, canned set of drills done but involves customization based on individual needs as they relate to especially proximal and distal joint function/deficits that directly impact stresses on that knee.
It amazes me how often surgeons and therefore their patients perceive this "new knee" as being truly a new knee and forget that the same deficient connective tissues, proprioceptors, weak muscles, and rewired motor programming to allow for substitution still remain post-op. The new surfaces on the femur and tibia don't change that. The tight ITB facilitating varus stresses, lack of STJ eversion, and lack of hip IR that often are present still remain once those new surfaces are in place. Addressing those areas can have a great impact on that patient's function and symptoms...and ultimately overall satisfaction.

Posted by Mike Napierala
on 4/20/2012 10:23 PM

My first thought on reading this was: what a natural role for PTs to step in and be part of that pre-operative educational component to help patients become more realistic about their expectations and thus improve their overall satisfaction with the outcome. We are the experts in function-whether it is an post-op arthroplasty, rotator cuff repair, or ACL-and the restoration of their functional movement capability afterward. It makes me crazy when a patient with severely limited knee ROM and transfer skills and the MD says, "why certainly you can drive because you are 4 weeks post-op", or the rotator cuff that can "return to golf" but has severe limitations in shoulder stabilization and limited ROM. We need to educate the public that we are the ones they need to turn to when they can't do something that they want to be able to perform.

Posted by Margaret Grey -> AFT`
on 4/23/2012 11:17 AM

50 year old male. 5 months out from knee replacement. Your article definitely brought me back to earth. I need to embrace the successes of the new joint. Ive had 5 conservative management procedures. Cppd condition exaserbated my situation. thx me

Posted by mark f stephenson
on 9/28/2013 5:59 AM

I'm 54 and it's three weeks after my surgery and I guess I'm ahead of the curve. At two weeks I was walking with no cane. I do have some heat at the incision and a feeling of my knee cap bumping sometimes. I'm guessing that is from the remaining swelling. I also have full motion.I have had very little pain at all. I guess I had gotten use to the three previous years of pain before my surgery. Maybe next year the other knee.